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. 2020 Dec:227:295-299.
doi: 10.1016/j.jpeds.2020.07.034. Epub 2020 Jul 11.

Optimizing Oxygenation of the Extremely Premature Infant during the First Few Minutes of Life: Start Low or High?

Ola D Saugstad  1 , Satyan Lakshminrusimha  2 , Maximo Vento  3
Affiliations

Optimizing Oxygenation of the Extremely Premature Infant during the First Few Minutes of Life: Start Low or High?

Ola D Saugstad et al. J Pediatr. 2020 Dec.
No abstract available

Keywords: FiO(2); delivery room; immature newborn.

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Figures

Figure 1.
Figure 1.
Principles of oxygen supplementation during resuscitation in extremely preterm infants. Stimulation of spontaneous breathing, glottic opening, establishment of functional residual capacity, and pulmonary vasodilation are crucial to achieve optimal oxygenation and heart rate. Simultaneously, oxidative stress–induced injury should be minimized. Copyright Satyan Lakshminrusimha. HR, heart rate.
Figure 2.
Figure 2.
Graphic abstract of the study by Dekker et al on the effect of initial high vs low FiO2 on breathing effort in preterm infants at birth. Copyright Satyan Lakshminrusimha.
Figure 3.
Figure 3.
Potential effects of brief use of higher FiO2 in the delivery room during mask and T-piece resuscitation of extremely preterm infants ≤25 weeks of gestational age at birth. Such factors as mask leak, intermittent glottic closure, lung liquid, and an immature surfactant-deficient canalicular lung reduce alveolar PAO2. Reduced surface area for gas exchange and increased distance of the air space–capillary interphase increase the alveolar-arterial oxygen gradient (A-a DO2) and reduce pulmonary venous PO2. Persistent right-to-left shunts at the oval foramen and ductus arteriosus and also “dilution” by umbilical venous blood during delayed or physiological cord clamping further decrease PAO2 and SpO2. Once adequate oxygenation is achieved, inspired oxygen can be weaned and titrated to the desired SpO2. Copyright Satyan Lakshmin-rusimha. PaO2, arterial oxygen tension; PO2, oxygen tension.
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References

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